Elevated serum tryptase in exercise-induced anaphylaxis☆,☆☆,★
Section snippets
CASE REPORT
K.Z., an 18-year-old male high school football player was seen in consultation; he was complaining of acute skin rashes and hives associated with exercise. He also stated that he could at times experience wheezing and dyspnea when the hives developed. However, not every outbreak of hives was associated with dyspnea, and at times, he noted that dyspnea could develop without hives. The hives could last up to 60 minutes after cessation of exercise, and dyspnea could last 30 to 45 minutes. This
DISCUSSION
This case report clearly and dramatically demonstrates the role of mast cells in EIA. The elevated plasma histamine levels mirror those previously reported, and the elevated serum tryptase levels further document mast cell involvement in an attack triggered by mild exercise at a medical care facility. Elevations in plasma histamine have previously been reported.3, 5, 6 Furthermore, alterations in tissue mast cells in skin biopsy specimens of patients with EIA have been described. 4, 7 A loss of
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Cited by (53)
Anaphylaxis: Advances in the Past 10 Years
2023, Journal of Allergy and Clinical Immunology: In PracticeCitation Excerpt :Serum tryptase levels were found to be elevated in some patients with anaphylaxis and others with SM in the 1980s.116 Since then, many articles demonstrated an increase in serum tryptase levels after an anaphylactic spell.117-124 Furthermore, elevated sBT levels were identified as a risk factor for severe Hymenoptera sting–induced anaphylaxis.125-127
Exercise-induced bronchoconstriction update—2016
2016, Journal of Allergy and Clinical ImmunologyAnaphylaxis—a practice parameter update 2015
2015, Annals of Allergy, Asthma and ImmunologyExercise-induced anaphylaxis
2015, Immunology and Allergy Clinics of North AmericaCitation Excerpt :Seasonal pollen exposure in pollen-sensitized patients11 As in other forms of anaphylaxis, mast cell activation and release of various mediators are believed to be responsible for the signs and symptoms of EIAn and FDEIAn, based on skin biopsies showing mast cell degranulation28 and demonstration of transient elevations in plasma histamine29,30 and serum tryptase after episodes.31,32 However, the specific changes that occur during exercise and that lead to symptoms, in the presence of food or independent of it, remain unclear.
A dangerous exercise lessons from food-dependent anaphylaxis for the physician
2014, American Journal of Emergency MedicineExercise-induced anaphylaxis
2011, Revue Francaise d'Allergologie
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From the Department of Medicine, Case Western Reserve University School of Medicine and the Airway Disease Center, University Hospitals of Cleveland.
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Reprint requests: Howard J. Schwartz, MD, 1611 S. Green Rd., South Euclid, OH 44121.
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